Pharmacy Students Begin Rotations at San Francisco Health Plan

The San Francisco Health Plan has completed an affiliation agreement with UCSF to provide managed care Advanced Pharmacy Practice Experience (APPE) rotations for fourth-year students enrolled in the School of Pharmacy.

The program began on March 31, 2014. The strong interest in the field of managed care prompted San Francisco Health Plan (SFHP) to create this rotation.

“We want to directly impact aspiring managed care pharmacy leaders,” said SFHP Director of Pharmacy Elizabeth Sampsel. “ The only way to do that is to set up a training program. We are very fortunate in this organization to have strong leadership and a supportive Governing Board to work with academic institutions such as UCSF, where education and moving to the next professional level and team-based care is encouraged.”

“We encourage innovative care models and this is our way of reaching out to academia to engage in innovative care models to train the next generation, ” added Sampsel.

UCSF pharmacy students are also working with Dr. Sampsel to establish SFHP as an Introductory Pharmacy Practice Experience (IPPE) site for first and second-year pharmacy students to gain exposure to managed care.

Dr. Sampsel recently spoke with Synapse about the organization’s forward-thinking structure and how it is rising to meet the needs of the recent changes in health care reform.

The County’s Safety Net

The City and County of San Francisco established the San Francisco Health Authority in 1994 to create an efficient, integrated health care delivery system in order to provide Medi-Cal beneficiaries and others access to comprehensive health care services.

The San Francisco Health Plan is one of California’s local health plans that provides care that is compassionate, respectful, culturally and linguistically appropriate, and ensures preservation of the safety net.

Today, SFHP oversees the delivery of medical services, such as preventative and specialty care, hospitalization and prescription drugs for more than 100,000 members. Additionally, SFHP is a third-party administrator for the Healthy San Francisco program operated by the San Francisco Department of Public Health (SFDPH) to provide access to health care services for San Francisco residents who are not eligible for Medi-Cal or financial assistance through Covered California.

SFHP is responsible for overseeing the health care needs of one out of every six San Francisco residents, according to Dr. Sampsel.

The SFHP Structure

Founded well before the creation and implementation of the Patient Protection and Affordable Care Act (ACA), SFHP shares the basic premise of the ACA: ensuring high-quality, affordable health care coverage for the uninsured and underserved. To meet the need, SFHP offers three plans for medical, vision and (in most cases) dental care through Medi-Cal, Healthy Kids, and Healthy Workers programs. Combined, these programs provide health insurance for uninsured individuals, families, persons with disabilities, children and seniors.

The integration of innovative health care models at SFHP ensures health care services for all San Francisco residents.

“We have the wonderful situation where geography works in our favor,” said Dr. Sampsel. “Our city is seven miles squared and getting people to their health care providers is possible and doable; it is not like rural communities where there can be logistic challenges. We are testing new innovative care models so that we can have better outcomes. Just because someone cannot afford health care does not mean that they don’t deserve the highest possible quality.”

Membership Growth at SFHP

Since the implementation of the ACA, SFHP membership has grown by an estimated 20,000 members and is expected to continue to grow throughout 2015. Many of these new members previously received care through SF PATH, a low-income health service program run by the SFDPH. As Medi-Cal members, this population has access to more services and more affordable health benefits.

With the significant expansion in eligibility and funding for Medi-Cal, the demographic of SFHP’s membership has grown. A nationwide study by the University of Michigan revealed that new enrollees into Medicaid were younger, male and Caucasian.

To respond to the changing demographics, SFHP employed inter-professional care teams to understand the health issues critical to each demographic.
“It takes the entire health care team to learn about these patients, learn about them quickly and develop programs that really suit their needs,” said Dr. Sampsel. “

Our goal is to meet people where they are.”

Physicians, inpatient and outpatient nurses, pharmacist , and social and case management workers comprise the inter-professional care teams that manage both inpatient and outpatient care.

“As a managed care plan, we are responsible for the oversight of our members’ care,” said Dr. Sampsel. “ If they are admitted to the hospital, our job is to oversee that process to make sure that they are getting the right care in the right place at the right time.”

Piloting Innovative Care Models

SFHP’s Care Support team, positioned within the community, identify homeless and transient residents who need care and who would otherwise use hospital emergency rooms as their primary source of care. Last year, the team collaborated with SFDPH and the City’s Direct Access to Housing as part of a grant to examine “housing first” as a solution for health care costs. This pilot program helped to find temporary housing for 50 homeless members.

Part of SFHP’s mission is to support and inspire the providers who serve their members, low- and middle-income San Franciscans. The SFHP provider network consists of seven medical groups each with an affiliated hospital within the San Francisco County. For most SFHP members, pharmacy services are managed by SFHP independently.

SFHP partnered with Walgreens Pharmacy to resolve two outstanding Healthcare Effectiveness Data and Information Set (HEDIS) measures. A pilot medication therapy management (MTM) study was constructed to evaluate targeted interventions for patients with severe asthma and those requiring lab monitoring because of drug therapy. The preliminary results from this study were very positive and received much attention.

SFHP is pioneering new care models in the diverse patient population of San Francisco.

“This is a great testing ground for innovative models in a variety of different patient types and demographics,” says Dr. Sampsel.

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